Ever wondered what it would be like to live in a psychiatric hospital?

Rosenhan probably wondered a bit too hard when he came up with the design for this study – the premises of the hypothesis were fairly simple: what is abnormality? Does abnormality mean randomly breaking out into laughter at an inappropriate moment or is there something more complicated to the entire concept? Furthermore, how do we know that a diagnosis made by a psychiatrist is valid and accurate?

The DSM (consider it a reference book for all psychologists and psychiatrists) started classifying mental abnormalities such as psychoses and neuroses according to the cluster of symptoms most common to these ailments. However, Rosenhan criticized this attempt as he thought it was too reductionist, did not take into account other factors or symptoms that might have important while making a diagnosis and might be unreliable since each psychiatrist has a different scale for making a diagnosis – something that makes the entire medical approach rather subjective.

Rosenhan decided to expose this unreliability of the psychiatric method by designing an experiment that would enroll the participants into a psychiatric ward, pretending that they were mentally ill.

Participants

Since this experiment’s participants were volunteers who agreed to be enrolled in a psychiatric ward for an indefinite period of time, the study was considerably more ethical than its predecessors. A group of eight people; five males and three females were recruited to be ‘pseudo-patients’; they had to fake a mental illness and gain admission into twelve psychiatric hospitals across five US states. They arranged an appointment by telephoning at the hospital and reported fake symptoms such as hearing voices of the same sex, hearing words such as empty, thud and hollow – meant to signify an existential crisis.

They used false names but retained their original life history when reporting for their appointment and were diagnosed by their respective psychiatrists as schizophrenic. Completely sane people who pretended to experience symptoms close to that of schizophrenics were diagnosed by psychiatrists as schizophrenic. Without any further consultation. Upon admittance to the hospital, they ceased showing their previous symptoms and instead began to converse with other patients, observe the patient-staff dynamic and began taking detailed notes about their experience in the ward.

Design

This experiment had two parts; the first part was to expose the negligence on the part of psychiatrists and their staff when it comes to taking care of the patients and the second part was to prove the unreliability of the medical method used by psychiatrists.

In the second experiment, the hospital where the first experiment took place was then informed (falsely so) that a number of pseudo-patients would attempt to gain entry into the hospital – their task was to rate each patient on a scale based on their likelihood to be faking insanity.

Results

The results were truly shocking as they exposed the invalidity of the entire medical method of psychiatry and revealed the brutality that patients had to face at the hands of the staff.

Almost all pseudo-patients hated being patients at the ward and tried extremely hard at trying to get out. It took one patient 52 days to make it out of the ward.

None of the staff or the psychiatrists suspected that the pseudo-patients might be faking their symptoms. 35/118 actual patients were skeptical of the pseudo-patients and remarked that they didn’t seem ‘insane’ and that they might be ‘journalists checking up on the hospital’. This shows us exactly how capable psychiatrists are of picking up the difference between a sane and an insane person.

Even the normal behavior of the pseudo-patients was labeled in the context of their psychiatric illness, such as their writing behavior was considered pathological and their hunger was labeled as a property of their oral-acquisitive syndrome.

None of the psychiatrists bothered to check up on their patients. The staff followed this example of negligence and spent less than seven minutes interacting with parents.

Many patients were in the habit of flushing down their medicines and while the staff noticed, they did not care enough to comment as long as patients were compliant.

In the second part of the experiment, a significant number of staff members were unable to accurately identify a pseudo-patient from an actual patient.

What’s so shocking about this study is that it pointed out the gaping holes in the psychiatric system and criticized the reductionist approach that psychiatrists took, going as far as to not even properly consult the patient and simply diagnose according to the DSM. However, it should be noted that Rosenhan didn’t mean to defame the profession but simply aimed to remove the shame that surrounds mental illness and advocated for a more compassionate, humane system so as to help the recovery of the patients.

In conclusion, we can’t always tell the insane from the sane. Even psychiatrists. Yes.

In the next edition, we’ll re-visit the story of Little Albert; an eighth-month baby who was conditioned into a variety of phobias and fears by one ingenious behaviorist – John B. Watson!